Reducing the Cost of Remoteness: Community-Based Health Interventions and Fertility Choices.

Distance to health centers can represent a significant healthcare cost for poor households. Community-based health interventions and community health workers can be an alternative to deficient formal health care provision among remote populations. We analyze the effects on fertility outcomes of a large-scale community-based health worker program that aims to reach remote areas distant from health facilities in Madagascar. We use a triple difference model that exploits time and geographic variation in the program rollout and the geocoded household distance to the closest health facility. Our findings indicate that the program decreased the probability of conception among women in treated areas but did not have a differential effect among women living in remote areas. A potential mechanism underlying this fertility reduction is that the program increased women's modern contraceptive use.

Maternal Age and Child Development.

Although the consequences of teen births for both mothers and children have been studied for decades, few studies have taken a broader look at the potential payoffs-and drawbacks-of being born to older mothers. A broader examination is important given the growing gap in maternal ages at birth for children born to mothers with low and high socioeconomic status. Drawing data from the Children of the NLSY79, our examination of this topic distinguishes between the value for children of being born to a mother who delayed her first birth and the value of the additional years between her first birth and the birth of the child whose achievements and behaviors at ages 10-13 are under study. We find that each year the mother delays a first birth is associated with a 0.02 to 0.04 standard deviation increase in school achievement and a similar-sized reduction in behavior problems. Coefficients are generally as large for additional years between the first and given birth. Results are fairly robust to the inclusion of cousin and sibling fixed effects, which attempt to address some omitted variable concerns. Our mediational analyses show that the primary pathway by which delaying first births benefits children is by enabling mothers to complete more years of schooling.

The impact of early life shocks on human capital formation: evidence from El Niño floods in Ecuador.

This paper investigates the persistent effects of negative shocks in utero and in infancy on low-income children's health and cognitive outcomes and examines whether timing of exposure matters differentially by skill type. Specifically, I exploit the geographic intensity of extreme floods in Ecuador during the 1997-1998 El Niño phenomenon, which provides exogenous variation in exposure at different periods of early development. I show that children exposed to severe floods in utero, especially during the third trimester, are shorter in stature five and seven years later. Also, children affected by the floods in the first trimester of pregnancy score lower on cognitive tests. Additionally, I explore potential mechanisms by studying health at birth and family inputs (income, consumption, and breastfeeding). I find that children exposed to El Niño floods, especially during the third trimester in utero, were more likely to be born with low birth weight. Furthermore, households affected by El Niño suffered a decline in income, total consumption, and food consumption in the aftermath of the shock. Falsification exercises and robustness checks suggest that selection concerns such as selective fertility, mobility, and infant mortality do not drive these results.

Family investment responses to childhood health conditions: intrafamily allocation of resources.

The onset of a health condition during childhood impairs skill formation. A number of studies have investigated the long-lasting effects of poor health during childhood on later-in-life outcomes. However, this evidence ignores how parents respond to the onset of health conditions. Do their investments reinforce the health condition? Or compensate, or behave neutrally? If parents change their investments, the relationship between early health and later outcomes combines the biological effect and the investment responses. To address this question, I use within-sibling variation in the incidence of health conditions to control for selection from unobserved household heterogeneity. Parents invest, on average, 0.16 standard deviations less in children with mental conditions relative to their healthy siblings, using a measure of investment that includes time and resources. On the contrary, when children have a physical condition, parental investments do not differ across siblings. Results are robust to alternative measures of health conditions and the inclusion of child fixed effects.